SEMS Placement Enables Effective Preoperative Total Colonoscopy for Cancer

The placement of colonic self-expandable metallic stents (SEMS) serves as a bridge-to-surgery for patients with obstructive colorectal cancer, creating a pathway that allows clinicians to perform a total colonoscopy before the primary surgical intervention. According to the PubMed study, this sequence enables the identification and treatment of synchronous cancers and neoplastic lesions located proximal to the primary tumor.

SEMS Success Rates and Procedural Timelines

The study enrolled 100 patients with obstructive colorectal cancer who underwent SEMS placement between April 2016 and March 2022. The success rate for SEMS placement as a bridge-to-surgery was 98.0%, though six patients experienced associated complications, according to the researchers.

For the 86 patients who moved forward with preoperative total colonoscopy, the procedure was performed within a window of 1 to 30 days following the stent placement. This timing allows for the assessment of the entire colon and the removal of potentially dangerous lesions before the main surgery takes place.

Identification and Resection of Synchronous Lesions

The use of preoperative TCS revealed a significant number of additional growths in the proximal colon. The study identified four patients with synchronous advanced cancers. Additionally, clinicians performed endoscopic resection on 116 adenomas, 18 sessile-serrated lesions, and nine non-advanced synchronous cancers.

The researchers reported no procedure-related complications during these resections, specifically noting an absence of bleeding, perforation, or stent migration. This indicates that the combination of SEMS and subsequent ER is a stable approach for managing multiple neoplastic lesions in the colon.

One-Year Surgical Outcomes

Follow-up data was collected for 45 patients who underwent a second total colonoscopy one year after their initial surgery. The data showed that the preoperative approach was highly effective in clearing precancerous lesions, as only one patient—who had submucosal invasive cancer—required a second surgery during the follow-up period.

The study concludes that this approach allows preoperative evaluation of the entire colon and the treatment of precancerous lesions without causing additional complications.